Pharmacies surviving ‘on the backs of people who don’t know any better’

CMs in half an orange

Criticism of the availability of non-evidence-based complementary medicines in pharmacy is emerging as one of several themes in the written submissions to the King Review.

To date the Review has received 37 written submissions available on the Health Department’s website.

The Review’s Discussion Paper noted that some consumers are concerned pharmacists may compromise on QUM and professional advice due to perceived financial pressures to up-sell by offering medicines which may not be necessary.

“It was also claimed that many complementary products do not have evidence-based health benefits and as such, the sale of these products in a pharmacy setting may misinform consumers of their effectiveness and undermine the professional integrity of community pharmacists,” the panellists noted.

Several submission authors raised this point. Consumer Andrew Woodman said he was prompted to make a submission to the Review after reading a Reddit comment thread in which a Redditor said he had been “swindled by a pharmacist” when he was sold homoepathic melatonin.

“It’s clear that this person was at the very least confused about a ‘supplemental’ treatment sold in a pharmacy and if he had not carefully read the label would not have ended up purchasing the  medicine he needed,” Woodman wrote.

“Walk into any pharmacy and you will see shelves upon shelves of vitamins, homeopathic remedies and other supplements. These are all almost universally useless in the vast majority of cases, and I’m sure the pharmacists know this.

“It looks to me that pharmacists are propping up their businesses on the backs of people who don’t know any better. I’m sure the profit margins on this snake oil is much higher than PBS listed medications.”

Consultant physician and consultant psychiatrist John Buchanan said that it is extremely confusing for patients if non-evidence-based “therapies” are sold alongside prescription medicines.

“My understanding is that the Australian community spends as much on ‘supplements and vitamins’ as it does on prescription medicines,” Dr Buchanan wrote.

“It would appear that the vast majority of these ‘supplements and vitamins’ are not of any demonstrated clinical benefit.

“From a medical point of view, the advertising of them is in fact laughable – so often one hears ‘preparation X may support the function of your thyroid/prostate/liver/whatever’.

“As well as the waste of money, it is of concern to many medical practitioners that patients use such supplements and vitamins, etc. in an attempt to self-medicate, which is often an unhelpful step, because it means that they avoid presenting for a proper medical assessment of whatever their difficulty is or symptoms are.”

And Geoff Sloan, a member of National Seniors Australia’s NT Policy Advisory Group, said he had in the past raised concerns with NSA about the marketing of supplements to its members; due to this concern he researched the efficacy of supplements and came to the conclusion that for most people they produce no advantage or discernible effect.

“For people with defined incomes, as most retired people have, expending significant amounts of that income on a product or products that provide little or no benefit is undesirable,” he wrote in his submission.

As an example he detailed a recent trip to a pharmacy to fill a cholesterol-lowering script, when he was asked “for the first time ever in a pharmacy” whether he suffered cramps or muscle pain at night. He said yes and without further investigation (Sloan is a keen cyclist who occasionally neglected hydration) was recommended a supplement.

“Even though I held a well-researched belief I felt under considerable pressure to purchase the item. I did not,” Sloan wrote.

“However, I feel that many people with less well established attitudes and opinion about supplements would have purchased the item, and once purchased would have become supportive of its use.

“I believe that this method is not confined to pharmacies in my town and feel that the practice could produce more harm than good, in that an expense is being incurred for a product of dubious value when the money could be spent more effectively on good advice and a better diet.”

But Dave Rees, a community pharmacy owner in Condobolin, was keen to help pharmacists access information about the evidence base for CMs, rather than simply condemning the entire sector outright.

“Trying to evaluate all the myriad of CAMs on the market and their evidence base can be overwhelming for a pharmacist with an already full work load,” Rees wrote in his submission.
“A system of accreditation (whether by the TGA or a separate body) for CAMs would be very valuable for pharmacy, as well as the wider health system.
“An idea I heard floated somewhere else envisaged a green tick logo, similar to the Heart Foundation tick for healthy foods, could be employed for products that are marketed only with claims that have a minimum level of evidence behind them.
“Details such as the minimum required level of evidence would need to be determined.
“This would  give a clear indication what has a place in community pharmacy (and legitimate healthcare) and what belongs in the realm of pseudo-scientific quackery.”

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  1. Michelle Gerrie

    Having worked in the USA for 12 years , i was introduced to the concept of integrative medicine and continue to have a keen interest in that area. I use the ‘Natural Medicines Comprehensive Database” as a guide. It is a fantastic resource for health professionals and I urge you to peruse the link below.

  2. Trail Blazer

    I love the idea of a “green tick” logo like the heart foundation “tick”. McDonald’s purchased the “heart foundation tick” for its food. LOL If complementary medicines, when prescribed by an experienced and qualified health practitioner during a consultation, are recommended to a patient and not taken up, that is the patient’s right to not take them and there should be no pressure involved. If complementary medicines do not work, why then, are so many people using them? It is definitely not advertising on the t.v. as that is geared towards drugs and the drug industry – so how are people finding out about them and why are they working?

  3. Angus Thompson

    I absolutely agree that community pharmacy’s participation in the ‘Great NEBCAM Scam’ is fundamentally unethical, however I would make two observations…
    – to imply that those ‘taken in’ by NEBCAMs ‘know no better’ makes implications that run contrary to my experience. Many of those who opt to take these products are actually quite well educated and have a reasonable disposable income, some simply have a mistrust of modern medicine e.g. are likely to be vaccine sceptics or statin sceptics. They are very selctive in where they source information from, dismissing anything that challenges their concept that ‘natural is safe and better’ and may often opt to use non-pharmacy suppliers for these products
    – to suggest that a ‘tick’ of approval would improve standards is a farce. The endorsement of many Omega-3 products by health organisations with charitable status is an example of how little this really means

  4. Jarrod McMaugh

    This does highlight an issue that there is quite a bit of closed-mindedness around CAM.

    Some people blindly believe that anything CAM is appropriate and works and is natural and makes you feel warm and fuzzy, etc.

    Some people blindly believe that anything CAM is without evidence, based in mysticism and witchcraft, and consists mainly of scams and snake oil.

    None of these points of view are correct.

    There are CAM products with quite good evidence base, just as there are allopathic products with very thin evidence base.

    Too often, people have a surrogate understanding in treatments based on the label CAM – in their mind there are two pigeon holes, and one is a good thing, one is a bad thing…. what label applies to which pigeon hole depends on your point of view.

    I’m pretty sick of people making broad statements about the safety or evidence base of “Specific Product” based on the label (or lack of label) of “CAM”. I am especially sick of hearing it from health professionals and anyone with a scientific background (especially members of the Friends of Science in Medicine) because taking the point of view that anything CAM is useless is about as unscientific as you can get.

    • Simon O'Halloran

      Completely agree and share your frustration and disappointment in vocal opponents of CAM and the “us vs them” stance. We need to be accessible and well informed to effectively guide our patients on the most appropriate products and avoid moving the advice on CAM into the domain of the hacks and quacks. The “scientists” seem to be steering the agenda that anything not AustR or on a script belongs with homeopathy, ear candles and iridology, which isn’t really a useful stance to be leading the profession. I don’t believe this is the intention but seems that is what is indirectly happening with positions published by the science superfriends et al.

  5. Daniel Roitman

    I made this point at one of the community consultations and I’ll make it here again.

    Any pharmacist/proprietor who stocks CAMs that have no evidence-base are one of two things: they are either incompetent or they are professionally negligent. Perhaps, they are a bit of both.

  6. russell HARDING

    stand in the shoes of the consumer

    Big Pharma meds as per the CMIs that we are supposed to be handing out, list many serious potential side effects.

    Complementary medicines are perceived as being safer and according to their neighbour or “the magazine” – might actually work. For most, we pharmacists probably don’t know if they are efficacious or not. Most likely not but where there is evidence we need to produce it.

    However, if we don’t stock them the consumer will purchase elsewhere no doubt about that. With the pbs pressures many pharmacies don’t have much choice to stock.

    it doesn’t matter how you phrase it, the consumer will give them a try and the likelihood of a misadventure is low, particularly after receiving advice about potential interactions from their pharmacist.

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